Pharmacist - Louisville, KY

Pharmacist
Louisville, KY

Under the direct supervision of the Sr. Pharmacy director, the Pharmacist will provide clinical pharmacy services, formulary education, and support on-going needs of all departments Medicare Advantage and Behavioral health needs.

Responsibilities:

•Review and approve physician inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria. Work in collaboration with the Medical Director on initial denials for further review and appeal.

•Handle calls and correspondence from providers. Research, resolve and respond to provider clinical inquiries. Maintain tracking and reporting for Medicare Appeals process in collaboration with the appeals department and policy.

•Work with appropriate individuals/vendors to facilitate compliance with pharmacy regulation, achievement of outcome scores for HEDIS NCQA and other accrediting body. Respond to physicians regarding requests on Drug Formulary. Respond to telephone inquiries from physicians, other healthcare professionals and members in collaboration with member services.

•Support Fraud and Abuse program system oversight.

•Serve as primary line contact for all internal Behavior health and Medicare advantage pharmacy related issues.

•Identify problems in process, procedures or services and make recommendations for improvements.

•Perform appropriate research, analysis and generates findings report. Submit recommendation to supervisor for review and input. May assist in implementation and/or coordination of project changes.
REQUIREMENTS
Requirements:

•Strong research and analytical ability
•Ability to extrapolate data and present research results
•Excellent interpersonal and organizational skills



Education:
•Bachelor of Science Degree in Pharmacy
•Doctor of Pharmacy Degree (PharmD) preferred

Experience:
•3 years Pharmacy experience
•Previous experience in managed care or a provider operated healthcare environment
•Experience in behavioral health medications, therapies and treatment of behavior health diagnosis. ( preferred)
•Experience with inpatient and outpatient behavior health services. ( preferred )

Licenses, Registrations or Certifications
•Current Pharmacy License in the Commonwealth of Kentucky preferred.
•If individual is not licensed in the state of Kentucky, license transfer is expected within 6 months of employment.



Reply to: 2379 Pharmacist DDD KY

David Dooley, Healthcare Project Manager
James L. Dooley & Associates, Inc
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